SPECIAL FOCUS: PRODUCTIVITY
A Map for Practice Efficiency
Workflow — the set of chronological tasks or procedural steps necessary to accomplish a complete process from start to finish — is closely related to efficiency. According to Wikipedia, efficiency “describes the extent to which time, effort or cost is well used for the intended task or purpose.” Efficiency is a measurable, “quantitatively determined by the ratio of output to in-put, which differs from effectiveness, “a relatively vague, non-quantitative concept, mainly concerned with achieving objectives.”
Have you thought of how your business works? Are you effective, efficient or both?
Many times, both can be improved by mapping and analyzing workflow. Below are three examples of workflow for reception, based three different levels of technology. Each offers opportunities for practice improvements that can save time and money, as demonstrated by the notes on page 23.
1 What does the person who answers the phone for an appointment say: “Mrs. Smith, could you please bring any and all glasses that you have to the appointment, including sunglasses, OTC readers and old back-up glasses? In addition, could you please bring any contact lenses and solutions that you use to the appointment so we can check out how they are fitting your eyes? Please also bring a form of payment as well as insurance cards, both medical and vision, that you have currently so we can verify insurance coverage prior to your exam.” This script, along with others, can prevent timely delays at the beginning of the exam as well as speed the exam at later stages by making it clear what prescriptions are valid and which type of contact lenses the patient is wearing, for example.
2 Is your team asking whether there are any other family members who may need an exam at the same time? This technique saves both time (since much of the history will be the same) as well as increases practice volume.
3 All elements in purple in the first workflow chart could be replaced with an EHR system. Most of these steps take up time but develop no increased efficiency or better information. In reality, these steps increase the risk of transcription errors, entry errors or information loss.
4 It should be clear that the consumer is responsible for his/her co-pay if managed care is involved as well as any fees for uncovered services. Also, it should be made clear at this step any other financial policies present within the practice. For example, the consumer should be notified that he/she is responsible for putting 50% down on all product orders.
5 Scheduling an appointment could also be done online with many EHR systems. This workflow element is key to the efficiency of the business. The person scheduling the appointment must be trained to ask the right questions to determine the potential length of the exam and reason for the visit. Other documentation, such as questionnaires, financial release, etc., can also be completed online with many systems.
All content in orange is workflow steps that could be aided or deleted with the aid of other technologies to create a more technology-integrated office
6 Insurance verification, though really the responsibility of the consumer, many times falls upon the office. This should ideally be done prior to the consumer arriving. If the consumer cannot give proof of insurance, then it may be a good idea to institute a policy that he/she be made aware that he/she is responsible for full payment on the day of service. You would never go to the grocery store for milk and walk out without paying. Should medical services be any different?
7 Many of the appointment reminder calls may also be eliminated by utilizing electronic technology, such as text messaging, e-mail or automated calling systems for appointment verification. This eliminates a great number of staff hours spent to just verify appointments.
8 This is a critical communication point to the transfer of key information from one staff member to another. Instead of “putting the chart in the rack,” this should be an e-mail, text, IM or verbal conversation to transfer all key information about the exam, payment or personal issues the consumer has discussed.
9 Think about the forms that you create. Could they be simplified? Are they providing meaningful information? Is any of this information better collected somewhere else in the process? If so, eliminate it from this step. Doing so also streamlines the entire workflow process by preventing information duplication.
10 There are multiple forms of scanning technology that can eliminate the paper trail. Laminate your forms, and have the patients sign them with a dry-erase marker. Then, scan the forms, erase the signature from the form and re-use the form. This little trick alone can save hundreds of dollars in print cartridges, paper and wasted physical chart space while at the same time allowing instance access.
Now, that you know where to start assessing workflow, add your changes to save valuable time. OM